Lower Readmissions Linked to Higher Risk of Death

An alarming new study suggests that the emphasis on reducing hospital 30-day readmissions has inadvertently led to increased risk of death for Medicare patients hospitalized with heart failure.

Gregg C. Fonarow, MD

As many as 10,000 heart failure patients could die prematurely each year because of misguided efforts that keep them out of the hospital to avoid the financial penalties attached to higher readmissions, according to a study published this week in JAMA Cardiology.

Study co-author Gregg C. Fonarow, MD, a researcher and professor of cardiovascular medicine at UCLA, spoke with HealthLeaders Media. The following is an edited transcript.

HLM: The implications of this study are staggering. What are we to make of them?

Fonarow: This study represents the sum of all fears. Concerns were raised about flaws in the readmission metric, flaws in the ways the penalties were being constructed and the potential and concern for unintended consequences. Now we’re seeing that.

That’s not to say that trying to reduce preventable readmissions is not important. But, it needs to be coupled with strong efforts to ensure patient safety and to reduce preventable deaths.

HLM: How many lives are we talking about?

Fonarow: If we were to extrapolate this to all Medicare beneficiaries hospitalized with heart failure, we are talking about maybe 10,000 patients a year with heart failure losing their lives as a consequence of this program. Even one patient being harmed isn’t worth any degree of readmission reduction but to have potentially each year 10,000 or more patients having been potentially impacted with increased mortality is just an absolutely devastating level of potential harm.

HLM: What’s wrong with the design of the policy?

Fonarow: The way Medicare constructed their readmission reduction program was solely focused on 30-day readmissions with strong financial penalties up to 3% of every Medicare dollar. But, when you look at what was Medicare doing to ensure patient safety and trying to incentivize around lower mortality rates, the maximum penalty a hospital could face, even with a 100% mortality rate, would be 0.2% of their total Medicare revenues. That’s sending a message 15X from a financial standpoint that it’s more important to reduce readmissions than to be focused on patient safety or mortality.